Key result
RAS inhibitors remain underused, prescribed to only ~35% of eligible type 2 diabetes patients.
Why the study?
Treatment patterns of renin-angiotensin system inhibitors in high-risk patients with type 2 diabetes and cardio-renal risk remain variable and under-characterized in real-world practice.
Cross-Sectional (n=33,524)
No
Less than half of high-risk patients with type 2 diabetes and hypertension or albuminuria in this real-world cohort receive guideline-directed renin-angiotensin system inhibitors, revealing a significant implementation gap.
Background: Renin-angiotensin system inhibitors (RASi) are recommended as first-line therapy for patients with type 2 diabetes (T2D) and chronic kidney disease (CKD), particularly in the presence of hypertension or albuminuria.This study assessed the treatment patterns in a cohort of high-risk T2D patients.Methods: This cross-sectional, retrospective study included 33,524 adults with T2D from the Imperial College London Diabetes Centre (United Arab Emirates).Demographic, clinical, and laboratory parameters (estimated glomerular filtration rate, urine albumin-to-creatinine ratio, and blood pressure (BP)), and medication usage were analysed.The primary outcome was the analysis of treatment patterns in patients undergoing RASi; secondary outcomes included prescribing trends in CKD risk categories and among hypertensive and albuminuric subgroups.Results: Among 33,524 patients with T2D, mean age was 59.2 years, BMI 29.4 kg/m 2 , and 67.1% (n=22,508) of the patients were classified as KDIGO (Kidney Disease: Improving Global Outcomes) G1 and 73.3% (n=24,580) as A1 albuminuria.Overall, 35.3% (n=13,705) received RASi, while 64.7% (n=25,128) were treated with alternative therapies including SGLT2 inhibitors, GLP-1 receptor agonists, or finerenone.Among patients with albuminuria >3.5 mg/mmol, only 62% (n=4944) were prescribed RASi, despite meeting clear indications for treatment.In KDIGO-based risk stratification, only 39% (n=4406) of patients in the high and very high CKD progression risk categories were on RASi.Among the hypertensive subgroup (n=4,824; defined as BP >130/80 mmHg), 48.96% (n=2,362) were prescribed RASi, leaving over 50% of patients untreated with this guideline-recommended therapy.Furthermore, 7.46% (n=2,462) of the entire cohort had hypertension but were not receiving RASi.This gap was more prominent among those with coexisting albuminuria or CKD.These findings reflect under-treatment even among those at greatest risk of renal and cardiovascular events.Conclusion: In patients with T2D and established renal or cardiovascular risk, treatment patterns remain variable in real-world practice.Less than half of hypertensive or albuminuric patients received RASi, highlighting a significant implementation gap.Addressing barriers to RASi prescription is essential to align real-world clinical practice with international guidelines and improve patient outcomes.
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Ahmed et al. (2026) conducted a cross-sectional in Type 2 Diabetes (n=33,524). Renin-angiotensin system inhibitors (RASi) vs. Alternative therapies or no RASi treatment was evaluated on Treatment patterns in patients eligible for or undergoing RASi therapy. Renin-angiotensin system inhibitors were underprescribed in clinical practice, received by only 35.3% of 33,524 type 2 diabetes patients and less than half of hypertensive or albuminuric subgroups.
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